A 39-year-old nonsmoking man presented to the hospital with intermittent episodes of exertional chest discomfort radiating to the arms, which was relieved with rest. He described the discomfort as pressure and heaviness. He also reported mild shortness of breath. He did not have orthopnea, paroxysmal nocturnal dyspnea, light-headedness, dizziness, or syncope.

His electrocardiogram and cardiac markers were normal. Because of persistent symptoms, cardiac catheterization for further evaluation was performed. The coronary angiogram revealed an anomalous takeoff of the right coronary artery from the proximal left anterior descending artery (Figs. 1 and 2, Online Video 1). Computed tomography with contrast of the coronary arteries delineated the course of the anomalous right coronary artery and ruled out compression of the vessel. Subsequent exercise stress test results were normal. Medical management was recommended because there was no compression. The patient was discharged home with nitroglycerin and remained asymptomatic at the follow-up visit.